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Private Voluntary Health Insurance : Consumer Protection and Prudential RegulationHealth care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance.
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Health Insurance Handbook : How to Make It WorkMany countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.
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Health Insurance Handbook : How to
 Make It WorkMany countries that subscribe to the
 Millennium Development Goals (MDGs) have committed to
 ensuring access to basic health services for their citizens.
 Health insurance has been considered and promoted as the
 major financing mechanism to improve access to health
 services, as well as to provide financial risk protection.
 In Africa, several countries have already spent scarce time,
 money, and effort on health insurance initiatives. Ethiopia,
 Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few
 of them. However, many of these schemes, both public and
 private, cover only a small proportion of the population,
 with the poor less likely to be covered. In fact, unless
 carefully designed to be pro-poor, health insurance can
 widen inequity as higher income groups are more likely to be
 insured and use health care services, taking advantage of
 their insurance coverage. The purpose of this handbook is to
 provide policy makers and health insurance designers with
 practical, action-oriented support that will deepen their
 understanding of health insurance concepts, help them
 identify design and implementation challenges, and define
 realistic steps for the development and scaling up of
 equitable, efficient, and sustainable health insurance
 schemes. The handbook takes policy makers and health
 insurance designers through a step-by-step series of
 considerations and tasks that need to be achieved. The
 handbook's philosophy is to not be dogmatic,
 ideological, or prescriptive. This handbook was prepared to
 be used in a six-day regional workshop. Clearly, health
 insurance design is an intensive political and technical
 process that takes much longer than six days. The
 expectation for the workshop is that by the end of the week,
 each team has a clear idea of next steps that they could
 take back home to engage other stakeholders and move toward
 scaling up and improving the performance of health insurance
 in their country.